The Debate About Lowering the Drinking Age

The Debate About Lowering the Drinking Age

Minimum Legal Drinking Age (MLDA) laws specify the legal age when an individual can purchase alcoholic beverages. The MLDA in the United States is 21 years.  However, prior to the enactment of the National Minimum Drinking Age Act of 1984, the legal age when alcohol could be purchased varied from state to state.1

An age 21 MLDA is recommended by the:

• American Academy of Pediatrics2
• Community Preventive Services Task Force4
• Mothers Against Drunk Driving5
• National Highway Traffic Safety Administration1
• National Prevention Council8
• National Academy of Sciences (National Research Council and Institute of Medicine)9

The age 21 MLDA saves lives and improves health.3

Fewer motor vehicle crashes

  • States that increased the legal drinking age to 21 saw a 16% median decline in motor vehicle crashes.6

Decreased drinking

  • After all states adopted an age 21 MLDA, drinking during the previous month among persons aged 18 to 20 years declined from 59% in 1985 to 40% in 1991.7
  • Drinking among people aged 21 to 25 also declined significantly when states adopted the age 21 MLDA, from 70% in 1985 to 56% in 1991.7

Other outcomes

  • There is also evidence that the age 21 MLDA protects drinkers from alcohol and other drug dependence, adverse birth outcomes, and suicide and homicide.4

Drinking by those under the age 21 is a public health problem

  • Excessive drinking contributes to more than 3,500 deaths among people below the age of 21 in the U.S. each year.10
  • Underage drinking cost the U.S. economy $24 billion in 2010.


  • There were about 189,000 emergency department visits by people under age 21 for injuries and other conditions linked to alcohol in 2010.


  •  More than 90% of the alcohol consumed by those under age 21 is consumed by binge drinkers (defined as 5 or more drinks per occasion for boys; 4 or more drinks per occasion for girls).13

Drinking by those below the age of 21 is also strongly linked with9,14,15:

  • Death from alcohol poisoning.
  • Unintentional injuries, such as car crashes,  falls, burns, and drowning.
  • Suicide and violence, such as fighting and sexual assault.
  • Changes in brain development.
  • School performance problems, such as higher absenteeism and poor or failing grades.
  • Alcohol dependence later in life.
  • Other risk behaviors such as smoking, drug misuse, and risky sexual behaviors.

Alcohol-impaired driving

Drinking by those below the age of 21 is strongly associated with alcohol-impaired driving.
The 2017 Youth Risk Behavior Survey16 found that among high school students, during the past 30 days

  • 6% drove after drinking alcohol.
  • 17% rode with a driver who had been drinking alcohol.

Rates of drinking and binge drinking among those under 21

The 2017 Youth Risk Behavior Surveillance System16 found that among high school students, 30% drank alcohol and 14% binge drank during the past 30 days.

In 2017, the Monitoring the Future Survey external iconreported that 8% of 8th graders and 30% of 12th graders drank alcohol during the past 30 days, and 4% of 8th graders and 14% of 12th graders binge drank during the past 2 weeks.17

In 2014, the New York City Department of Health and Mental Hygiene and the New York State Liquor Authority found that more than half (58%) of the licensed alcohol retailers in the City sold alcohol to underage decoys.19

Enforcing the age 21 MLDA

Communities can enhance the effectiveness of age 21 MLDA laws by actively enforcing them.

  • A Community Guide review found that enhanced enforcement of laws prohibiting alcohol sales to minors reduced the ability of youthful-looking decoys to purchase alcoholic beverages by a median of 42%.18
  • Alcohol sales to minors are still a common problem in communities.

More information on underage drinking

  1. National Highway Traffic Safety Administration. Determine Why There Are Fewer Young Alcohol Impaired DriversExternalexternal icon. Washington, DC. 2001.
  2. Committee on Substance Abuse, Kokotailo PK. Alcohol use by youth and adolescents: a pediatric concernExternalexternal icon. Pediatrics. 2010;125(5):1078-1087.
  3. DeJong W, Blanchette J. Case closed: research evidence on the positive public health impact of the age 21 minimum legal drinking age in the United StatesExternalexternal icon. J Stud Alcohol Drugs. 2014;75 Suppl 17:108-115.
  4. Task Force on Community Preventive Services. Recommendations to reduce injuries to motor vehicle occupants: increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired drivingCdc-pdfExternalpdf iconexternal icon [PDF-78 KB]. Am J Prev Med. 2001;21(4 Suppl):16-22.
  5. Mothers Against Drunk Driving (MADD). Why 21? 2018; icon. Accessed May 3, 2018.
  6. Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired drivingCdc-pdfExternalpdf iconexternal icon [PDF-2 MB]. Am J Prev Med. 2001;21(4 Suppl):66-88.
  7. Serdula MK, Brewer RD, Gillespie C, Denny CH, Mokdad A. Trends in alcohol use and binge drinking, 1985-1999: results of a multi-state surveyExternalexternal icon. Am J Prev Med. 2004;26(4):294-298
  8. National Prevention Council. National Prevention Strategy: Preventing Drug Abuse and Excessive Alcohol Usepdf iconexternal icon [PDF-4.7MB]. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011.
  9. Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective ResponsibilityExternalexternal icon. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press; 2004.
  10. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC.
  11. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumptionExternalexternal icon. Am J Prev Med. 2015;49(5):e73-79.
  12. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN report: highlights of the 2010 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visitsCdc-pdfExternalpdf iconexternal icon [PDF-410 KB]. Rockville, MD. 2012.
  13. Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice.Drinking in America: myths, realities, and prevention policyExternalexternal icon. Washington, DC. 2005.
  14. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school studentsExternalexternal icon. Pediatrics. 2007;119(1):76-85.
  15. Department of Health and Human Services. The Surgeon General’s call to action to prevent and reduce underage drinkingExternalexternal icon. Department of Health and Human Services, Office of the Surgeon General;2007.
  16. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance United States, 2017. MMWR Surveill Summ 2018;67(No. SS-8):1–114.
  17. Miech RA, Schulenberg JE, Johnston LD, Bachman JG, O’Malley PM, Patrick ME. National adolescent drug trends in 2019: findings released.external iconexternal icon Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2019.
  18. Elder R, Lawrence B, Janes G, et al. Enhanced enforcement of laws prohibiting sale of alcohol to minors: systematic review of effectiveness for reducing sales and underage drinkingExternalexternal icon [PDF-4MB]. Transportation Research E-Circular. 2007;E-C123:181-188.
  19. The New York City Department of Health and Mental Hygiene. Alcohol & Health. 2015; icon. Accessed October 18, 2016.


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